Provider Demographics
NPI:1902994049
Name:DESERT RIDGE REHABILITAION AND HEALTH GROUP, LLC
Entity Type:Organization
Organization Name:DESERT RIDGE REHABILITAION AND HEALTH GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-563-8450
Mailing Address - Street 1:8575 E PRINCESS DR
Mailing Address - Street 2:205
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5483
Mailing Address - Country:US
Mailing Address - Phone:480-563-8450
Mailing Address - Fax:480-247-7655
Practice Address - Street 1:8575 E PRINCESS DR
Practice Address - Street 2:205
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5483
Practice Address - Country:US
Practice Address - Phone:480-563-8450
Practice Address - Fax:480-247-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20093349332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ5543950001Medicare ID - Type Unspecified